Using the LACE Index to Predict 30-day All-cause Unplanned Readmission and Mortality in Acute Myocardial Infarction Patients: Insights from the CADOSA Registry

Abstract

Background: Inappropriate use of CT pulmonary angiography (CTPA) imposes significant burden on health care system. Clinical guidelines recommend using Well's score, Pulmonary Embolism Rule Out Criteria (PERC) score and d-dimer in the clinical decision making to reduce number of unnecessary CTPA. Method(s): We conducted a retrospective cohort study of adult ED patients who underwent CTPA for suspected pulmonary embolism (PE) between June and October 2017. We aimed to determine the percentage of CTPA that could have been avoided when the Well's score was combined with PERC score and/or D-dimer. Result(s): A total of 360 patients were available for analysis. The mean age was 60.1 +/- 16.9 years, 193 (53.6%) were females. The diagnostic yield of CTPA was 7.2% (26 of 360). According to guidelines, 68 (18.9%) CTPA investigations could have been avoided. This includes patients with: (1) a low-risk Wells score (<2), PERC (-) and/or D-dimer negative 52 (14.4%); (2) PERC (+) and D-dimer negative 12(3.4%); (3) Intermediate Wells score (2-6) and D-dimer negative 4 (1.1%). 137(58.3%) patients with low Wells score and PERC (+), and 58 (69.0%) patients with intermediate risk well score should have had D-dimer testing as part of their PE evaluation but did not. Conclusion(s): Almost 20% of patients with suspected pulmonary embolism were subjected to unwarranted CTPA when risk assessment scores were not adhered to.Copyright © 2019